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Get Wcb Alberta Pharmacy Form C774
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How to fill out the Wcb Alberta Pharmacy Form C774 online
The Wcb Alberta Pharmacy Form C774 is essential for submitting prescription invoices related to work-related injuries or illnesses. This guide aims to provide clear instructions for completing the form online, ensuring all necessary information is accurately included.
Follow the steps to complete the Wcb Alberta Pharmacy Form C774 online.
- Press the ‘Get Form’ button to access the form and open it in your preferred document editor.
- Begin by entering the WCB claim number in the designated field at the top of the form. Ensure this number is accurate as it is crucial for processing your claim.
- Provide the provider’s invoice number clearly in the corresponding section to link your submissions effectively.
- Fill in the worker's personal details including their surname, first name, middle initial, address, personal health number, and date of birth. Ensure all information is correct to prevent processing delays.
- Indicate the date the prescription was dispensed in the format YYYY/MM/DD. This is important for the billing timeline.
- Next, input the quantity of the medication being billed along with the Drug Identification Number (DIN) and a description of the drug. Double-check these details for accuracy.
- Record the date of the accident using the YYYY/MM/DD format and include the name of the prescribing doctor for clear identification.
- Fill in the total amount being billed. This should include all line items previously entered, ensuring that it has been calculated correctly.
- After reviewing the completed sections, require a provider's signature and the date of submission, ensuring that all documentation corroborates the claim.
- Finally, include the name and address of the pharmacy to whom the payment fee is payable. Don’t forget to add the necessary fax and telephone numbers for contact purposes.
- Once you have filled out all sections, save the changes, download the document if necessary, and prepare it for submission by mail or fax as indicated on the form.
Begin the process by filling out the Wcb Alberta Pharmacy Form C774 online today.
You generally have one year from the date of the injury to file a WCB claim in Alberta. This time frame is crucial to ensure you receive your benefits. In some cases, exceptions may apply that allow for claimed injuries to be reported beyond this period. Utilizing the Wcb Alberta Pharmacy Form C774 can provide clarity and assist you in correctly submitting your claim within the required timeframe.
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